Prioritising the generation of evidence on infant and young child feeding interventions in emergencies

The need for evidence-based humanitarian interventions is gaining momentum, as discussed in a recent blog entry by Jeremy Shoham and Marie McGrath. Unfortunately, as noted by the two Field Exchange founders, “the few reviews of evidence in humanitarian nutrition programming show that there is very little ‘probabilistic’ evidence out there.” Knowledge gets passed on from one emergency to the next by the humanitarian workers, missing the opportunity to influence standards and encourage best practice more systematically. Time will be needed before the gaps are filled. In the meantime, humanitarian actors need to respond to emergencies according to current best practices and standards, but they also need to generate evidence to improve these practices where necessary.

This is also the case for infant and young child feeding, a sub-area of nutrition programming. If practised optimally, the feeding of infants and children under two is the single most effective intervention to save children’s lives: it could prevent almost a fifth of deaths in under-fives. This is even more relevant in humanitarian emergencies where child deaths can escalate. Yet, engaging in optimal feeding practices during emergencies – such as feeding young children five times a day with a varied and nutritious diet whilst continuing breastfeeding – is especially challenging several reasons. For example: food insecurity hampering the procurement of nutritious food; psychological trauma affecting child care practices; and non-targeted distributions of breast-milk substitutes potentially undermining breastfeeding and increasing the risk of water-borne diseases. Interventions for protecting, supporting and promoting optimal feeding include social and behavioural change, interpersonal communication for promoting breastfeeding and complementary feeding, provision of donated complementary food or micronutrient powder and psychological support to caregivers.

Nevertheless, the choice and use of interventions for infant and young child feeding in emergencies is one of the areas in the nutrition sector with the least available evidence from published articles or unpublished material. In contrast, a wealth of evidence, including systematic reviews and meta-analyses, has been generated for some of these interventions in non-emergency settings, all of which the humanitarian sector can draw from. However, determining its applicability is not without challenges. Specific circumstances linked to emergencies might influence delivery models and their effectiveness, and might warrant the generation of new evidence in these specific contexts. As a first step towards filling this gap, Save the Children has decided to identify the most pressing questions, so that Save the Children itself, together with other practitioners, researchers and donors, can focus efforts to generate evidence around the most pressing issues.

Based on interviews with experts in the subject, we developed a list of about 50 research questions and applied four criteria to create a ranking based on answerability, operational relevance, disease burden reduction and prevention, and originality. Using an online survey, 27 key specialists from NGOs, universities and research institutions, and UN organisations prioritised the research questions.

The main gaps in evidence relate to programme design and evaluation of interventions. The top research questions were related to: use of cash transfers to buy breast-milk substitutes; effectiveness of complementary feeding strategies; long-term effect of interventions; design of programmes in contexts where breastfeeding rates are low and breast milk substitute use is high; and design of effective re-lactation interventions.

The full result of this exercise, the first of its kind, is publicly available. We hope it will form the basis of future research on this topic and be integrated into the agenda of relevant stakeholders for generating the much-needed evidence and leveraging funds to fill the gaps and resolve the uncertainties.

Evidence Aid passionately believes in making evidence freely available to humanitarians, whoever and wherever they are. But our resources need money to produce, translate and maintain.

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